The Future of the Affordable Care Act and Insurance Coverage.

PATIENT Protection & Affordable Care Act; HEALTH insurance; REPEAL of legislation -- Social aspects; HISTORY of United States Congress; MEDICAID law; HEALTH insurance subsidies; TAX credit laws; COST control in health insurance; TWENTY-first century; HISTORY; HISTORY of public health; PRACTICAL politics; HEALTH care reform; HEALTH services accessibility; INSURANCE; PATIENT Protection & Affordable Care Act -- Economic aspects; MEDICAID; GOVERNMENT aid; PREEXISTING medical condition coverage

We describe the patterns of coverage gains associated with the Affordable Care Act (ACA) expansions and use these patterns to assess the potential impact of alternative repeal or repeal and replace strategies because Congress and the president are weighing options to repeal or replace the ACA. We find that specific provisionsof the ACA, including the Medicaid expansion and the structure of premiumsubsidies, have been associated with large and robust gains in insurance coverage. We evaluate the impact of retaining dependent coverage and high-risk pool provisions and show, on the basis of the ACA experience, that these provisions would have little effect on coverage. We find that many replacement proposal components, including flat tax credits and maintaining cost savings provisions, could jeopardize the ability of many of the ACA's primary beneficiaries, as well as other Americans, to access coverage and care. By leading to a deterioration of the safety net, these strategies could also imperil population health activities. [ABSTRACT FROM AUTHOR]

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